Healthcare Provider Details

I. General information

NPI: 1386759561
Provider Name (Legal Business Name): PAMPA ORTHOPEDICS AND REHAB, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N HOBART SPACE 2J
LUBBOCK TX
79065
US

IV. Provider business mailing address

25 BRIERCROFT OFFICE PARK
LUBBOCK TX
79412-3011
US

V. Phone/Fax

Practice location:
  • Phone: 806-665-4820
  • Fax: 806-665-4123
Mailing address:
  • Phone: 806-795-7433
  • Fax: 806-795-7407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateTX

VIII. Authorized Official

Name: LIESL LYNN OLSON
Title or Position: OWNER
Credential: PT
Phone: 806-795-7433